Learning Together to Work Together: Considerations for Interprofessional Education

Interprofessional education (IPE) has become a topic at the forefront of healthcare education due to recent, radical changes in healthcare. These changes stem from increased regulation from organizations such as the Centers for Medicare & Medicaid Services (CMS), Department of Health and Hospitals (DHH), and The Joint Commission, new healthcare policies, and the changing roles of providers such as the increased scope of practice of healthcare practitioners in the wake of the COVID-19 pandemic.

Provider roles have changed to serve individuals, families, and communities, specifically in rural environments. These cohorts with complex needs and rights are far beyond the capacity of any one profession to respond to adequately. Delivering care, stems from decision-making and communication within multidisciplinary teams. However, previous research indicates that there are still significant gaps in communication between professions, despite education in respective professional fields such as nursing and health information management that emphasizes the importance of collaboration and communication between disciplines.¹

Educators have been called to bring students from differing professions together to enable more effective teamwork, interprofessional communication, and collaborative practice in a way² the World Health Organization (WHO)³ refers to as “learning together to work together.” In response, administrators in the College of Nursing and Allied Health Professions at the University of Louisiana at Lafayette sought to develop an IPE course. 

Background and Overview of Interprofessional Education

The fundamental premise of interprofessional education asserts that if students from two or more professions learn from and about each other throughout their training, they will be better prepared to deliver an integrated model of collaborative care in practice. Multiple terms have been used to describe IPE in the literature: shared learning, interprofessional training, multidisciplinary education, and multi-professional education.⁴ Most of these terms are used interchangeably without a general agreement of meanings. In this article, the primary definition that we use to describe a broad definition of IPE comes from the WHO: “When two or more professions learn with, from, and about each other to improve collaboration and the quality of care.”⁵ ​ Students from different health science backgrounds actively engage together early in their training to develop skills necessary to collaborate successfully. Collaboration among students/professionals may occur in various settings, both clinical and non-clinical.⁶

Accrediting bodies are striving to create accountable statements that guide the implementation of IPE into education curriculum to ensure a standards can cross over different professions. Two accrediting bodies factor heavily into the curriculum in creating an IPE course at the University of Louisiana at Lafayette: The American Association of Colleges of Nursing (AACN) and the American Health Information Management Association (AHIMA). AACN defines IPE as occurring when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as members of the collaborative practice team. This is a crucial step in moving health systems from fragmentation to a position of strength.⁷

The AHIMA definition of IPE aligns with the WHO definition. AHIMA describes IPE as occurring when participants from different disciplines learn from and with each other. A guest presenter from another discipline, for example, does not meet the definition—the learners must interact with each other. The collaboration among the learners may occur in the workplace, in a classroom, or different settings. Also crucial in the interprofessional education definition is the objective of improving health outcomes, which extends the initiative’s impact beyond education and into practice.⁸ Comparing these two definitions shows that nursing and health information management (HIM) professions have a similar understanding of what IPE entails: emphasizing effective collaboration and communication between disciplines to affect and improve healthcare outcomes positively. Interactions must occur in various settings for this education to be effective. ​

Need for IPE in Health Sciences Education

Teaching an ethics course by using IPE is not a new concept. Medical students and nursing students have often been paired together to learn about ethical concepts allowing for discussion on how each profession would handle a dilemma. The differing views allowed for the early development of mutual respect and could potentially prevent moral burnout amongst medical professionals.⁹

IPE is a method that encourages students to explore how their professions can work together to respond more fully to the complex needs of the healthcare populations they serve. IPE enables health sciences students to understand different professional perspectives, cultures, and norms that can help overcome ignorance and prejudice among healthcare professionals and inform and inspire closer collaboration between them to improve services and the care delivered. Students are able to gain exposure expressing their viewpoints within a psychologically safe environment of the classroom and are on an even playing field that allows them to discuss ethical dilemmas without the worry of repercussion. Organizations set forth guidelines for curriculums in healthcare education as a critical strategy for addressing ongoing collaboration problems between professions. They call for the expansion IPE implementation across classrooms, simulation environments, and clinical settings.¹⁰

The aims and objectives of IPE and ethics coincide in numerous ways. Both IPE and ethics intend to ultimately improve the care and service that the public receives from healthcare practitioners. also includes the values and principles governing an individual or group. An IPE course offers an opportunity for students to come together for the mutual benefit of learning about ethical, personal, and professional values and the factors that influence other professionals in their decision-making. Healthcare ethics is a subject that most healthcare professionals already study at some point in their curriculum. Ethical issues are also topics on which there is often interprofessional conflict. Unlike some other areas of conflict, no one healthcare profession is recognized as having a superior understanding of ethical debates. Different viewpoints should be valued in an ethical debate, and no one viewpoint is correct. An ethics class built with IPE in mind offers a unique opportunity to encourage students to work together on issues where not one of them has a claim to a superior opinion. This fosters an atmosphere of cooperation between professions that can extend beyond the bounds of a single class period.¹¹ ​

Benefits and Barriers to Implementation of an IPE Course

The literature notes numerous benefits to implementing IPE courses. Evaluations of IPE courses have highlighted that students develop greater confidence concerning interprofessional skills and develop knowledge and skills for collaborative working, which have been shown to influence practice and improve patient-centered care. IPE assists in raising awareness of the roles and responsibilities of other healthcare providers and creating a better understanding of the contributions of healthcare team members. IPE courses facilitate interprofessional communication and prepare students for dealing with the intricacies of teamwork.¹²

IPE tends to work best with students who have shared ethical dilemmas and allows for the development of shared moral language, discourse, or reflection.¹³ Ethics courses based on IPE concepts can promote all the following: communication, mutual respect, shared planning and decision-making, evaluation of patient-centered care, increased cultural sensitivity, improved perceptions of and attitudes toward healthcare providers, networking opportunities, and overall better ethics education.^14,15 Finally, the most important benefits of an IPE-based ethics course include decreased hospitalizations, morbidity, and recovery time for patients and increased patient satisfaction.¹⁶

Despite the positive benefits that IPE courses have demonstrated, the literature notes specific barriers. There are logistical barriers that include scheduling classes, available space, large numbers of health sciences students, problems with faculty buy-in, workload additions, and administrative support. There may also be a lack of shared values and respect between faculty members. ​Program-specific barriers can include the availability of experienced faculty, appropriate textbook choice, funding of courses, differing accreditation standards, and differing professional requirements.¹⁷ The University of Louisiana at Lafayette considered these barriers and met the challenges head-on when developing its IPE course. ​

A significant program barrier presented—appropriate textbook choice—presents a unique challenge to those developing an IPE course. Nursing ethics and ethics of other professions were developed precisely to explore the different values that non-physicians bring to the healthcare table. Integrating these courses without providing a suitable interdisciplinary text could be detrimental to allowing independence and shared learning of the professions (i.e., the course is under the control of nursing, and therefore students of HIM professions must learn nursing-focused ethical concepts).¹⁸ ​A key enabler of IPE within health sciences professions in the academic setting is leadership. The importance of educational leadership in support of IPE has been recognized in the literature. Support for IPE is needed from leadership to highlight intentions for change, set outcomes, provide resources, and hold individuals responsible for outcomes. Implementation of IPE within the health sciences academic setting requires leaders who can create both a vision and provide sense-making of IPE.^{14​ 19}

​Notes

1. K. Sundberg, S. Reeves, A. Josephson, & J. Nordquist. (2019). Framing IPE. Exploring meaning of interprofessional education within an academic health professions institution. Journal of Interprofessional Care, 33, (6): 628-635. https://doi.org/10.1080/13561820.2019.1586658.

2. Machin, L.L., K. M. Bellis, C. Dixon, H. Morgan, J. Pye, P. Spencer, and R.A. Williams. 2019. “Interprofessional Education and Practice Guide: Designing Ethics-Orientated Interprofessional Education for Health and Social Care Students.” Journal of Interprofessional Care 33 (6): 608–18. https://search-ebscohost-com.ezproxyprod.ucs.louisiana.edu/login.aspx?direct=true&AuthType=ip,cookie,uid,url&db=edsbl&AN=vdc.100091627558.0x000001&site=eds-live&scope=site.

3. Framework for Action on Interprofessional Education and Collaborative Practice.” World Health Organization (WHO). World Health Organization, 2010. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice.  

4. Hazelwood, Anita, Lisa Delhomme, and Scott Sittig. 2019. “Collaborative Allied Health and Nursing Interprofessional Health Education: Beginning the Journey.” Online Journal of Interprofessional Health Promotion, 1, (1): 1–17. https://doi.org/https://doi.org/10.1080/13561820.2018.1538113.  

5. WHO

6. Hazelwood, Delhomme, & Sittig, pg. 5. 

7. American Association of Colleges of Nursing (AACN), “Interprofessional education”, AACN, 2021, https://www.aacnnursing.org/Interprofessional-Education   

8. Lalani, Karima H., and David L. Gibbs. 2018. “Relevance of Interprofessional Education for HIM Professionals.” Journal of AHIMA, January 1. https://search-ebscohost-com.ezproxyprod.ucs.louisiana.edu/login.aspx?direct=true&AuthType=ip,cookie,uid,url&db=edsbl&AN=RN617828787&site=eds-live&scope=site.

9. Stephen Hanson. (2005) “Teaching healthcare ethics: Why we should teach nursing and medical students together.” Nursing Ethics 12, (2): 167-176. https://doi.org/10.1191/0969733005n3773oa.  

10. K. Sundberg, S. Reeves, A. Josephson, & J. Nordquist. (2019).

11. Hanson, pg. 172

12. Hazelwood, Delhomme, & Sittig, pg.6 - 7

13. Hanson, pg. 168.

14. Hazelwood, Delhomme, & Sittig, pg. 6

15. Hanson, pg. 172-173.

16. Hazelwood, Delhomme, & Sittig, pg. 6

17. Hazelwood, Delhomme, & Sittig, pg. 7

18. Hanson, pg. 169

19. K. Sundberg, S. Reeves, A. Josephson, & J. Nordquist. (2019).